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Flecanaide for PACs
I know PACs are generally considered benign and do not need treatment, but I have been dealing with a 33% burden of PACs for a little over a year. They are consistent and constant, with the skip + hard beat that is common with PACs happening roughly every third beat, asleep or awake, at rest or active. I was referred to a cardiologist, who first put me on metropolol, which helped reduce the hard thumping feeling, but didn't reduce the number of PACs. Then switched to diltiazem which didn't help at all. Then switched to verapamil, which seemed to lessen the hard thumping a little, without lowering my heartrate as low as metropolol did. Then I was referred to an EP. He said ablation wasn't an option for me, since with PACs, it would be like "whack a mole" trying to eliminate the misfiring. So he put me on flecainide, 50 mg twice a day, plus 120 mg of verapamil. I must say, the constant thumping and skipping beats has completely stopped. It's amazing how noticeable it is after so long of having it happen constantly. But now I am seeing all the pretty dire warnings about flecainide. I did have both an echocardiogram and a nuclear stress test done recently, and there are no signs of heart disease, no clogged arteries, etc. Only finding was a moderately leaky mitral valve. I go for an ECG in a couple of days, so the EP can see how I'm responding to the flecainide. Has anyone ever taken flecainide for anything other than afib? I'm wondering if it's worth the risk for what the regular cardiologist said was a "benign" condition. A 33% PAC burden seems like it would eventually put strain on my heart, meaning it should be treated?
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I think you might as well consult a different EP.
https://medshun.com/article/cardiac-ablation-for-pacs
The article claims 90% success rate for ablating PACs. If your EP knows something contrary about you, I wish he/she had pointed it out. Otherwise............................find another EP.
Another article: https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.862659/full
https://pmc.ncbi.nlm.nih.gov/articles/PMC10103565/
In the right hands, with an EP experienced in handling PACs, you should expect to be successfully ablated. What I don't know specifically is why your EP says you're not a good candidate. He might just be right, but a second opinion would confirm it.
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2 ReactionsI don't have as high a burden of PACs - I’m in the 18 - 20% realm. A year ago I had an ablation which wasn’t successful (errant impulse is too close to the SA node) and have been on 100 mg Flecainide twice daily. Unfortunately the PACs haven’t decreased. Tomorrow I’ll be admitted to the hospital for 2 nights to try Tikosyn. I’m hoping this will improve the ongoing shortness of breath and fatigue that I’ve been experiencing since the PACs were identified 2-1/2 years ago.
Wishing you well in improving your situation.
I'm not a physician but I'm skeptical that a >30% PAC burden should be considered benign. For one, there's a lot of evidence that a high PAC burden can lead to AF. And my understanding is that even in the absence of AF, those PACs may cause damage, eventually leading to cardiomyopathy. IMO you're correct in getting this addressed and treated. Best of luck in getting this sorted out.
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1 Reaction@rusjr The research I have seen recently shows the curve adjusting upward slightly for morbidity due to PAC burden at only 3%. It was a slight gradient change, but obvious and given to pause. I agree with you that 30% burden is excessive and dangerous, and I would urge someone with only a 10-15% burden to seek the services of a good electrophysiologist.